Provider Demographics
NPI:1144271396
Name:EVERGREEN ULTRASOUND, INC
Entity type:Organization
Organization Name:EVERGREEN ULTRASOUND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT, RT(R)
Authorized Official - Phone:509-747-7427
Mailing Address - Street 1:PO BOX 8162
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-0162
Mailing Address - Country:US
Mailing Address - Phone:509-747-7427
Mailing Address - Fax:888-343-6937
Practice Address - Street 1:3026 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2560
Practice Address - Country:US
Practice Address - Phone:509-747-7427
Practice Address - Fax:888-343-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA408822471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty